Prostatitis - is an inflammatory condition of the prostate gland which is not always caused by infection. It is extremely common, with up to half of all men developing symptoms of it at some stage during their life.

Types of prostatitis

Bacterial prostatitis occurs if a urinary infection secondarily infects the prostate. If it is successfully treated within a few days it is known as acute but if it persists it becomes chronic.

Non-bacterial prostatitis describes inflammation within a prostate gland without any evidence of bacterial infection (usually because it has been successfully treated, but despite this the inflammation persists).

Prostatodynia means 'painful prostate' and is characterised by the symptoms of prostatic inflammation but without evidence of inflammation or bacterial infection. It is also known as chronic pelvic pain syndrome (CPPS).

Symptoms of Prostatitis

Acute

Fever and chills.

Frequent, urgent and painful urination.

Joint, muscle and back ache.

Pain in penis, testicles and area between the scrotum and the rectum (perineum).

Painful ejaculation.

Chronic

Painful urination.

Recurring urinary infections.

Discomfort in genitals and perineum.

Back ache and abdominal pain.

Painful ejaculation.

Blood in semen.

Complications of prostatitis

Prostatic abscess - a serious condition, in which a collection of pus can cause severe pain, fever and a rapid deterioration in health. It is only relieved by drainage of the abscess bursting or if it bursts.

Acute urinary retention - the inability to pass any urine, which needs to be relieved by inserting a catheter (tube) to drain the bladder.

Chronic prostatitis.

Septicaemia (blood poisoning).

Investigations for Prostatitis

Digital rectal exam (DRE) to determine if the prostate gland is tender or swollen.

Blood tests to measure inflammatory markers, the health of the urinary system and PSA.

Urine culture.

Prostate massage, following which the first urine sample, which contains the expressed prostatic secretions, is cultured for infection.

CT scan of abdomen and pelvis to ensure the health of other organ systems, if all tests are negative for prostatitis.

Nonbacterial prostatitis is diagnosed when tests reveal no bacteria in the urine or prostatic secretions. There is no test to diagnose prostatodynia; which is diagnosed after eliminating other probable causes.

Treatment of Prostatitis

- Warm baths.

- Medication

painkillers.

antibiotics - it is important to use an antibiotic which penetrates the prostate well (most don't) for a sufficient length of time (usually 6 weeks). The quinolone family of antibiotics is best for this, such as ciprofloxacin and norfloxacin.

anti-inflammatory drugs - such as Brufen, Neurofen and Diclofenac.

antidepressant drugs - effective in many patient with neurogenic (nerve-mediated) pain. Prescribed and supervised by an expert in chronic pain relief, such as Dr Lucy Ward. Consultant anaesthetist and pain specialist.

prostate block - long-acting local anaesthetic administered under ultrasound guidance around the prostate to block the nerves subserving pain either as a diagnostic manoeuvre or as treatment.

Surgery

In cases of chronic bacterial prostatitis or prostatodynia, surgery (TURP) to remove part of the prostate is a treatment option. It is only recommended for patients who experience chronic, debilitating pain despite medication and importantly does not guarantee a resolution of the problem.

Alternative treatments for Prostatitis

Prostatitis can be difficult to treat. Acute, chronic, or nonbacterial prostatitis are inflammatory and/or infectious conditions that can be treated naturally with lifestyle changes, nutritional support, and herbal medicine, in some cases. The key to this approach is the elimination of inflammatory agents from the diet while supplementing with anti-inflammatory nutrients, foods, and herbs. Naturopathic methods may be applied with antibiotics and may even improve their effectiveness.